The Ethical Arguments against Direct to Consumer (DTC) Advertising
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- Introduction
Direct to consumer (DTC) advertising refers to the promotion of prescription drugs to the public by pharmaceutical companies through print, broadcast, or electronic media to influence the public to use the promoted drugs. The main avenues used in DTC advertising are television and internet and most of the spending is on television promotions (Byrne & Weeks, 2009). Direct to consumer marketing has become more pronounced because of several factors. According to statistics, there was a 300% increase in DTC advertising spending between 1996 and 2005 (Donohue, Cevasco, & Rosenthal, 2007). The increase in DTC advertising has been accompanied by a drastic decline in advertisements targeted at health professionals. As well, the amount spent in DTC advertising far exceeds that spent in the research and development of new drugs (Angell, 2004; Shaw, 2008).
The main factor that has led to a surge in DTC advertisements is the removal of restrictions on DTC advertisements by the Food and Drug Administration (FDA) in 1997. Prior to this, pharmaceutical companies were only required to provide the brand name of the medicine and list its benefits and adverse effects. Removal of the restrictions allowed the drug companies to promote a drug’s brand name as well as provide a telephone number or referral websites where consumers can obtain more information about the drug. Removal of the restrictions also exempted the pharmaceutical companies from risk disclosure requirements (Shaw, 2009).
This position paper argues that DTC advertising is ethically and morally wrong because it does more harm than good and should as such be outlawed or regulated.
- Profit Motive and the Effect of DTC Advertising on Health Costs
Pharmaceutical companies have greatly benefitted from DTC advertising through increased sales of branded drugs and higher profits (Donohue, Cevasco, & Rosenthal, 2007). This is a good thing because higher profits for these companies means that they can be able to survive in the competitive pharmaceutical industry and use some of the revenues generated to research and develop newer drugs that would help advance healthcare. Like other companies, pharmaceutical companies exist because of the profit motive where the costs incurred in production are lower than the benefits. They are business entities that need to get reasonable returns for their investments and this is best exemplified by the limited period for patent expiries. Pharmaceutical companies invest a lot of money in the research and development of new drugs. They have a limited period during which their patent is protected by law and after which generic drugs that are based on the brand can be formulated and marketed for sale. Entry of generics usually lead to dramatic price cuts that may render the original brand unprofitable and lead to losses for the pharmaceutical company behind the brand. According to Berndt (2000), there was decline in revenues amounting to $6.5 billion for drugs that lost patent protection in the year 2000. Thus, the pharmaceutical companies need to recoup their investment before the expiry of the patent period and DTC advertising helps them recover their investment and make some profits.
Whereas the pharmaceutical companies need to make profits and recoup their investments, use of DTC advertising ends up hurting more people and leads to more harm than good as they cause medicines to become more expensive and increase overall healthcare costs. The DTC advertisements convince the public to ask their doctors to prescribe for them expensive brands. As a result, insurance companies end up paying more for medications and this has made the insurance companies to increase premiums, co-pays, and deductibles in order to cater for the increasing medication costs. Patients end up asking for unnecessary and high cost medicines and this hurts businesses, as they have to dedicate higher amounts to healthcare insurance.
Besides, the DTC advertisements yield disproportionately higher incomes for pharmaceutical companies. A report by the Kaiser Foundation states that each dollar that is spent on DTC advertising yields an extra $4.2 in sales and that DTC advertising led to a 12% increase in the sales of prescription medicines in 2000. This translated to an extra $2.6 billion (Kaiser Family Foundation, 2000). This shows that pharmaceutical companies end up benefiting more than the consumers benefit. Based on this observation, DTC advertisement is morally wrong as it helps the pharmaceutical companies make more money at the expense of consumers. The consumers are persuaded to increase their purchases because they believe the advertized products are the best for consumption.
- DTC Advertisements and the Right to Free Speech
Proponents of DTC advertisements correctly argue that these advertisements are protected by the constitution through the First Amendment, which guarantees all citizens the right to free speech. The key idea in the First Amendment, which is relevant in this context, is the proposition that speech should not be restricted because of its content. Obviously, DTC advertisement would fall within the scope of this provision. Therefore, the argument can be made that the government cannot muzzle DTC advertisements because commercial speech is part of free speech. However, this paper contends that this is not a blanket guarantee and that there are several exceptions to the right to free speech. A case in point is the Central Hudson Gas & Electric v. Public Service Commission case where the Supreme Court ruled that commercial speech could be regulated if it is deceptive or promotes an illegitimate product. Critics argue that many DTC advertisements are often deceptive because they promise consumers quick fixes without mentioning any adverse effects. As such, these advertisements ought to be regulated. Based on this point, we argue that DTC advertisements are not only ethically wrong but also unconstitutional and should be regulated or outlawed.
- The Principle of Autonomy and DTC Advertisements
According to Rottenberk (nd), patient autonomy is the greatest ethical principle in medicine. Patients need to know as much as possible about their disease and the risks and benefits associated with a particular medicine. Patients also need to be involved fully in their treatment and be allowed to make informed decisions about the kind of treatment they want to receive. All these are the foundations of the autonomy principle.
Proponents of DTC advertising argue that these advertisements are beneficial because they enhance patient autonomy. They enhance patient autonomy because they offer much needed information about available drugs to the public. The information provided by the advertisements helps to bridge the gap between information demand and information provision. The advertisements in essence provide lessons to consumers on what causes a particular disease, the symptoms, how the medicine works, and the common side effects. This helps to enhance patient autonomy, which is an important ethical consideration as they are able to take part in the treatment decision-making process as well as control the direction of their treatment. It also helps to improve patient compliance since the patients will be more inclined to take the prescribed dosages of medicines they took part in selecting. The information provided by the advertisements is also beneficial because it prevents the underuse of medicines especially in the treatment of chronic conditions (Donohue, Cevasco, & Rosenthal, 2007).
Another benefit of this information is that it helps to eliminate paternalism where doctors are considered the only source of knowledge. Surveys carried out by the FDA in 1999 and 2002 discovered that more than half of all the doctors surveyed considered that DTC advertisements were useful because they improve patient-doctor discussions. More than 40% of the doctors surveyed believed that DTC advertisements provide invaluable information to patients on the available treatments (Rados, 2004).
However, we contend that the information that is provided by the DTC advertisements does little if any to enhance patient autonomy because of several reasons. First, the information provided by all DTC advertisements is meant to increase the sales of the particular drug being advertised. As such, these advertisements usually have positive information about the drug and the patient is usually left with a positive impression about the drug being advertised.
Based on the information presented by DTC advertisements, it is hardly right to say that these advertisements give the patient all the data they need to have about a particular medication. This is because the advertisements are usually presented in such a way as to impress upon the patient the need of taking the medicine being advertised with little regard to the adverse effects of the medicine. The advertisements are merely selling tools that do not adequately provide all the information needed for one to make a fully informed decision. It can thus be argued that the DTC advertisements do not have the capacity to enhance patient autonomy.
Viewed in this light therefore, the argument about DTC advertisements being beneficial because they allow patients to make informed decisions about their treatment falls flat on its face. This is because autonomous decisions are those that are made by a person who is fully informed and fully understands the medication he is requesting.
Whereas the importance of the information provided by the DTC advertisements cannot be entirely ruled out, it can also lead to the patients falsely diagnosing their conditions and may raise ethical dilemmas with regard to autonomy, beneficence, and non-maleficence. All these points support our argument about the unsuitability of DTC advertisements.
- DTC Advertisements, Beneficence and Non-maleficence
Besides patient autonomy, the principles of beneficence and non-maleficence are also important in healthcare practice. The principle of beneficence commits all health workers to do everything possible to ensure that the patient gets the best care possible. On the other hand, the principle of non-maleficence requires the healthcare provider to do no harm to the patient.
Regarding the principle of beneficence, DTC advertisements place pharmacists and doctors in an ethical dilemma especially when patients demand for medicines they saw being advertised and which the pharmacist knows is sub-optimal or unnecessary for their condition. Attempts by the pharmacist or doctor to let the patient know about the unsuitability of such drugs may be rebuffed and this may place the doctor in a quandary on whether to respect the patient’s autonomy or adhere to the principle of beneficence.
For the pharmacist and the doctors to comply with the principle of beneficence, they may need to infringe on the patient’s right to autonomy. This is true when viewed within the context of a patient who has been convinced by DTC advertisements about the efficacy and suitability of a particular drug for his or her condition but which in reality the healthcare provider knows will not be of benefit or will be of sub-optimal benefit to the patient. DTC advertising thus has the potential of bringing up ethical dilemmas for the healthcare provider. This also implies that healthcare providers may be obligated to adhere to the principle of beneficence where the patient’s only basis for seeking a particular treatment is information obtained from a DTC advertisement and points at the inappropriateness of the DTC advertisements.
Regarding the principle of non-maleficence, respecting a patient’s autonomy simply because the patient saw a DTC advertisement and thought that the drug would work well for the patient may lead to harm to the patient. This is especially true if the drug in question is contraindicated for the patient or is to be taken with caution. Prescribing a drug that may cause harm to a patient simply because the prescriber wants to respect the patient’s autonomy may lead to harm.
- Other Arguments against DTC Advertisements
We also contend that DTC advertisements are ethically and morally wrong because they can upset the relationship between doctors and their patients (Spake & Matthew, 2007) and create an inappropriate demand for particular drugs (Huh & Langteau, 2007). These advertisements are also inappropriate because they can pressure a medical doctor to make certain prescriptions and this is disadvantageous especially if a doctor has no experience with a particular drug. Moreover, the advertisements cause medicine overuse and this may lead to unwanted health effects (Donohue, Cevasco, & Rosenthal, 2007).
The casual manner in which FDA provides oversight on the DTC advertisements is also a reason why these advertisements are inappropriate. Misleading advertisements are not detected and acted upon in a timely manner and this can be very costly to the health of patients. On average, it takes about four months for the FDA to issue a regulatory letter. Additionally, FDA has committed a very small number of reviewers to evaluate advertisements. When considered against the backdrop of the large number of DTC advertisements, it is very difficult for misleading or improper DTC advertisements to be detected before harm is done. Compounding this problem is the fact that pharmaceutical companies are not required to present their advertisements to the FDA for review before mass distribution. All these factors make it impossible for erroneous advertisements to be identified early enough and as such it is easy for erroneous and potentially harmful information to be passed on to the consumer (Shaw, 2008; Donohue, Cevasco, & Rosenthal, 2008).
Finally, DTC advertisements are ethically and morally wrong because they can injure the relationship between pharmacists or doctors and their patients. Pharmacists usually have a very strong relationship with members of the community, which they serve. This is because community pharmacies are usually the first point of call for people seeking medication or medical information for particular ailments. Whereas DTC advertisements can enhance this relationship, they can also harm this pharmacist-customer relationship. Strengthening of the relationship can occur when individuals coming across the DTC advertisement visit their pharmacist to seek more information about the drug being advertised. However, promotion of drugs as consumer items can harm the pharmacist-patient relationship. This can happen since the DTC advertisements may portray prescription medicines as products to be sold on demand by clerks who answer to the name of pharmacists. The dispensing of prescription medicines becomes commercialized and the customers look at pharmacies as ventures that purely exist to make profits from individuals.
- Conclusion
Direct to consumer marketing has helped pharmaceutical companies to increase their sales and recoup their investments before expiry of patent periods. However, it has led to high costs of medicine and increased insurance premiums. Most of the advertisements are deceptive and do not provide full disclosure hence should not be categorized as free speech but should be outlawed. The advertisements do not enhance patient autonomy and only bring up ethical dilemmas for doctors, as they have to grapple between the principles of autonomy on one hand and beneficence and non-maleficence on the other hand. The ethical and moral wrongness of DTG advertisements is also manifested by their capacity to upset the relationship between doctors and their patients, create an inappropriate demand for particular drugs, pressure a medical doctor to make certain prescriptions and cause medicine overuse leading to unwanted health effects. Moreover, it is difficult to detect misleading DTC advertisements in a timely manner and this usually results in potentially harmful information being passed on to the consumer.